Thread by @hyderabaddoctor

When an old woman started speaking in a "foreign" accent all of a sudden
1. About a year back, a 70-year old woman was brought by her son to my OPD. As per him, she had started to speak Telugu in an "American" accent, since waking up that morning.
#MedTwitter #NeuroTwitter

2. She was illiterate, had no relatives or friends from USA and had never travelled to USA.
She had been confined to home for several months due to Covid lockdown and her son took her to a #psychiatrist, thinking she had developed this #Speech #abnormality due to stress.

3. Psychiatrist could not find any behavioral disorder and wanted a neurologist opinion.
Clinical examination revealed a problem with her speech. It was slow, and she had difficulty in clearly pronouncing words. It felt as if she was speaking Telugu in an American English accent

4. BP was 170/100 mmHg. Neurological examination was normal.
MRI brain showed a small acute infarct in left frontal area (speech area of brain).
A final diagnosis of "Foreign Accent Syndrome" (FAS) due to a #stroke in speech area of brain was made.

5. She was started on anti-platelet agents and BP-lowering drugs. Speech therapy was advised. Her accent slowly improved and it became normal at 6-month follow up.

6. FAS is a rare disorder characterized by the emergence of a perceived foreign accent following brain damage. Besides stroke, FAS can be caused by head injury and psychological causes. It was first described more than 100 years ago (in 1907) by French neurologist Pierre Marie.

7. Take home message
*Sudden change in accent can be a neurological problem and it is caused by damage to speech area of brain, most commonly by stroke.
*Proper evaluation & MRI can confirm the diagnosis. Medical treatment suffices in most. Changed accent may persist for long.